Isolation and identification of pathogenic Aspergillus and Fusarium spp. from clinical materials ... more Isolation and identification of pathogenic Aspergillus and Fusarium spp. from clinical materials provide the most accurate means for establishing a diagnosis of infections by these molds. Such efforts, however, are not always successful. Histologic diagnosis also has its limitations. In vivo the hyphae of Aspergillus and Fusarium spp. are very similar and their in situ manifestations are not pathognomonic. To improve the histologic diagnosis of infections by Aspergillus and Fusarium species, we developed polyclonal fluorescent-antibody reagents to Aspergillus fumigatus and Fusarium solani and evaluated their diagnostic utilities. Our studies revealed that A. fumigatus and F. solani share epitopes not only with one another but also with other Aspergillus and Fusarium spp. as well as with Paecilomyces lilacinus and Pseudallescheria boydii. Adsorption of the A. fumigatus conjugate with cells of Fusarium proliferatum and F. solani and F. solani antiserum with cells of Aspergillus flavus...
Disseminated penicilliosis marneffei is an emerging opportunistic mycosis seen in severely immuno... more Disseminated penicilliosis marneffei is an emerging opportunistic mycosis seen in severely immunocompromised human immunodeficiency virus (HIV)-infected patients and is caused by the dimorphic fungus Penicillium marneffei. Early diagnosis and treatment improve clinical outcome. Proper diagnosis is complicated by nonspecific signs and symptoms and by difficulties in histologic recognition and species identification of the pathogen. Since no established immunodiagnostic methods for penicilliosis marneffei are available, we attempted to develop separate immunodiffusion tests to detect P. marneffei antigens and antibodies in patient serum specimens and a latex agglutination test for antigenemia. Antigens consisted of 2-week-old fission arthroconidial filtrates produced in Pine's broth at 37 degrees C. Rabbit antisera were prepared against the 10 x -concentrated filtrate antigens. Studies were carried out with 17 serum specimens from HIV-seropositive adult Thai patients with penicill...
Kaufman, Leo (Communicable Disease Center, Atlanta, Ga.) and William Kaplan . Preparation of a fl... more Kaufman, Leo (Communicable Disease Center, Atlanta, Ga.) and William Kaplan . Preparation of a fluorescent antibody specific for the yeast phase of Histoplasma capsulatum . J. Bacteriol. 82: 729–735. 1961.—Rabbit anti- Histoplasma capsulatum globulin was conjugated with fluorescein isothiocyanate. This labeled antibody, in addition to staining six strains of H. capsulatum , exhibited strong cross-staining with ten strains of Blastomyces dermatitidis and numerous other species of fungi. Adsorption of the labeled antiglobulin either twice with cells of B. dermatitidis or twice with cells of Coccidioides immitis and once with cells of B. dermatitidis resulted in a good staining fluorescent antibody reagent, specific for yeast phase cells of H. capsulatum . Attempts to define the specific labeled antibody by the Ouchterlony procedure were unsuccessful. The specific conjugate did not give a complement fixation titer with yeast phase cells of B. dermatitidis or with coccidioidin. It did, ...
The diagnosis of penicilliosis marneffei can be difficult because the clinical manifestations mim... more The diagnosis of penicilliosis marneffei can be difficult because the clinical manifestations mimic those of tuberculosis, histoplasmosis, and other mycotic infections. Furthermore, the tissue form of Penicillium marneffei can be confused with those of Histoplasma capsulatum and Cryptococcus neoformans. To facilitate the rapid detection and identification of P. marneffei in clinical materials, we sought to develop a specific indirect fluorescent-antibody (IFA) reagent for this dimorphic pathogen. Preliminary IFA studies with yeast-like cells (fission arthroconidia) of P. marneffei indicated that these cellular elements stained with antiglobulins against culture filtrate antigens and whole yeast-like cellular antigens. Both types of antiglobulins reacted with the yeast-like cells of P. marneffei and with H. capsulatum, but not with their respective mycelial forms. The antiglobulins also failed to react with the yeast and hyphal forms of a variety of other heterologous fungi. Specific...
Conventional serodiagnosis of Pythium insidiosum infections involves the use of the immunodiffusi... more Conventional serodiagnosis of Pythium insidiosum infections involves the use of the immunodiffusion (ID) test. This test specifically diagnoses human and animal pythiosis. The test, however, has limited sensitivity and does not detect some culturally proven cases of the disease. Because of the increased recognition of pythiosis among humans and animals, we developed and evaluated an enzyme-linked immunosorbent assay (ELISA) using a soluble antigen from broken hyphae of P. insidiosum. Studies were carried out with sera from five humans and eight animals with culturally and/or histologically proven pythiosis. Some of these sera were negative in the ID test for pythiosis. Heterologous case sera from thirteen humans and two horses, plus 5 sera from healthy humans and 17 from healthy animals, were tested. Of the pythiosis case sera tested, the ID test detected only 8 of 13 (61.5%), whereas the ELISA detected all of them (100%). The ID and ELISA tests were entirely specific and gave negat...
A western blot (WB) test was evaluated for detection of antibodies against native glycosylated an... more A western blot (WB) test was evaluated for detection of antibodies against native glycosylated and chemically deglycosylated M and H antigens of Histoplasma capsulatum in serum obtained from patients during the acute phase of pulmonary histoplasmosis that occurred during an outbreak. Of 275 serum samples tested by immunodiffusion and complement fixation (CF) samples from 40 patients affected during this outbreak and from 37 negative controls were tested by WB test. A group of patients whose sera were negative for CF antibodies and precipitins early in the acute stage of histoplasmosis but who all seroconverted during convalescence 6 weeks later were tested with the WB test. Antibodies against untreated H and M antigens were detected at a 1:100 dilution by WB test in 45% of the 20 acute-phase serum samples and in all 20 of the convalescent-phase specimens. The WB test’s sensitivity for acute-phase specimens increased to 90% (18 of 20 specimens) when H and M antigens were treated by p...
Numerous reports have indicated that a single histoplasmin skin test may stimulate humoral antibo... more Numerous reports have indicated that a single histoplasmin skin test may stimulate humoral antibodies to Histoplasma capsulatum antigens in histoplasmin-hypersensitive individuals. Although these investigations concur that antibody elevations are evoked, they vary in the reported degree of incidence and response induced, and they cast doubt on the interpretation of serological tests in the diagnosis of histoplasmosis. Histoplasmin-hypersensitive subjects (114) were bled prior to administration of the skin test, 2 days later, at the time this test was read, and 15 and 30 days after testing. No significant antibody titers were observed at 2 days. At 15- and 30-day intervals, only 17 (15%) of the subjects demonstrated circulating antibodies. All 17 showed agar gel bands; 5 demonstrated no complement-fixation (CF) titers, 10 produced CF antibodies ranging from 1:8 to 1:16, and 2 demonstrated titers of 1:32. The data suggest that skin testing does not interfere significantly with antibod...
Kaufman, Leo (Communicable Disease Center, Atlanta, Ga.), and Sharon Blumer . Occurrence of serot... more Kaufman, Leo (Communicable Disease Center, Atlanta, Ga.), and Sharon Blumer . Occurrence of serotypes among Histoplasma capsulatum strains. J. Bacteriol. 91: 1434–1439. 1966.—Extensive studies with a fluorescent antibody specific for the yeast form of Histoplasma capsulatum indicated that, although most strains of H. capsulatum stained intensely, others stained weakly and some did not stain. These observations suggested that antigenic variants of the fungus existed. To test this hypothesis, reciprocal cross-staining and adsorption procedures were performed with fluorescein-labeled antiglobulins to four strains of H. capsulatum . Fifty-six strains of H. capsulatum and 11 strains of H. duboisii were studied. The data indicate that at least five serotypes of H. capsulatum occur. One is closely related antigenically to H. duboisii and Blastomyces dermatitidis .
Complement fixation titers of 1:2 and 1:4 with coccidioidin are not always of diagnostic signific... more Complement fixation titers of 1:2 and 1:4 with coccidioidin are not always of diagnostic significance. The concurrent use of the complement fixation and immunodiffusion tests is an effective means for specific serologic diagnosis of coccidioidomycosis in patients with low levels of complement-fixing antibodies. In routine testing, it is recommended that only sera that are negative for complement-fixing antibodies at 1:8 but positive in the immunodiffusion test with coccidioidin be selected for titration at the 1:2 and 1:4 levels.
A newly developed latex agglutination (LA) test and a modified immunodiffusion (ID) test were eva... more A newly developed latex agglutination (LA) test and a modified immunodiffusion (ID) test were evaluated. The antigen used was a homogenate of Candida albicans. A total of 167 antisera were employed in the evaluation. They included 36 sera from clinically well persons; 78 from patients with various clinical forms of candidiasis; 52 from patients with proven cases of aspergillosis, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, nocardiosis, paracoccidioidomycosis, sporotrichosis, and tuberculosis; and one serum from a patient with torulopsosis. Use of the LA test in conjunction with the ID test permitted the detection of more than 90% of 43 proven candidiasis cases. Of all the heterologous cases and normal human sera tested, LA reactions were noted with 3 of 10 cryptococcosis case specimens, 1 of 9 tuberculosis case specimens, and with the torulopsemia case serum. In contrast, the only heterologous serum reactive in the ID test was that from the patient with torulopsemia. Torulopsis glabrata and C. albicans antisera gave identical reactions in LA and ID tests with T. glabrata or C. albicans antigens. ID tests with selected antigens, however, permitted differentiation of rabbit and human T. glabrata antibody from that of C. albicans antibody. Six different precipitins were recognized with the C. albicans antigens. The occurrence of multiple precipitin lines and high LA titers was suggestive of severe candidiasis. The LA test, in contrast to the ID test, appeared to have prognostic value. Together, the LA and ID tests provided a simple, rapid, and accurate means of detecting and monitoring infections by species of Candida.
Maximal serological diagnosis of cryptococcosis may be accomplished through the concurrent use of... more Maximal serological diagnosis of cryptococcosis may be accomplished through the concurrent use of three tests: the latex agglutination (LA) test for cryptococcal antigen, and the indirect fluorescent antibody (IFA) and tube agglutination (TA) tests for Cryptococcus neoformans antibodies. These tests were applied to 141 serum and cerebral spinal fluid specimens from 66 culturally proven cases of cryptococcosis and to 42 sera from normal subjects and from patients with other systemic mycotic diseases. The LA test was sensitive and completely specific; of the sera from proven cases, 55% were positive. With the TA test, 37% of the specimens were positive and the test was highly specific. With the IFA test, 38% of the specimens were positive and the test appears to be the least specific of the three. Cross-reactions were most evident with blastomycosis and histoplasmosis case sera. When the three tests were used concurrently, 87% of the cryptococcosis case specimens were positive and permitted a presumptive diagnosis of C. neoformans infections in 61 (92%) of the 66 patients whose specimens were examined.
Previous studies have shown that a single skin test to histoplasmin may induce complement-fixing ... more Previous studies have shown that a single skin test to histoplasmin may induce complement-fixing antibodies or M precipitins (or both) to histoplasmin in histoplasmin-sensitive, but serologically negative, individuals. Ideally a skin-test antigen should be one which detects hypersensitivity without stimulating humoral antibodies. Histoplasmin skin-test antigens presently used contain both H and M antigens. The present study was undertaken to evaluate an histoplasmin skin-test antigen deficient in the M component but containing the H antigen. Thirty histoplasmin-hypersensitive subjects were bled prior to administration of the experimental skin-test antigen and at various time intervals thereafter. Only six of the thirty hypersensitive subjects showed serological responses. The sera of the six, however, only showed weak precipitin reactions, five showed M bands, and only one showed an M and an H band. None showed complement-fixation titers with either the yeast or mycelial antigens of Histoplasma capsulatum. Our data suggest that the use of a skin-test antigen purified to contain only H component would detect histoplasmin hypersensitivity without inducing antibodies and would eliminate false-positive serological reactions caused by the M component.
The American Journal of Tropical Medicine and Hygiene, 1999
In June 1994, 18 people developed serologically confirmed histoplasmosis following cave explorati... more In June 1994, 18 people developed serologically confirmed histoplasmosis following cave exploration associated with the annual National Speleological Society Convention in Bracketville, Texas. Six others had an undiagnosed illness suspected to be histoplasmosis. Two persons were hospitalized. We conducted a survey of convention attendees and a nested case-control study of those entering caves. We also conducted a histoplasmin skin test survey of a subgroup of the society, the Texas Cavers Association, who were attending a reunion in October 1994. Among the national convention attendees, exposure to two caves was identified as responsible for 22 (92%) of the 24 cases; 12 (75%) of 16 people exploring one cave (Cave A) and 10 (77%) of 13 exploring a separate cave (Cave B) developed acute histoplasmosis. Additional risk-factors included fewer years of caving experience, longer time spent in the caves, and entering a confined crawl space in Cave A. Of 113 participants in the separate skin test survey, 68 (60%) were found to be skin test positive, indicating previous exposure to Histoplasma capsulatum. A positive skin test was significantly associated with male sex and more years of caving experience. Those less experienced in caving associations should be taught about histoplasmosis, and health care providers should pursue histories of cave exposure for patients with bronchitis or pneumonia that does not respond to initial antibiotic therapy.
Identification of the newly named pathogenic oomycete Pythium insidiosum and its differentiation ... more Identification of the newly named pathogenic oomycete Pythium insidiosum and its differentiation from other Pythium species by morphologic criteria alone can be difficult and time-consuming. Antigenic analysis by fluorescent-antibody and inmunodiffusion precipitin techniques demonstrated that the P. insidiosum isolates that cause pythiosis in dogs, horses, and humans are identical and that they were distinguishable from other Pythium species by these means. The immunologic data agreed with the morphologic data. This indicated that the animal and human isolates belonged to a single species, P. insidiosum. Fluorescent-antibody and immunodiffusion reagents were developed for the specific identification of P. insidiosum.
An enzyme immunoassay (EIA) inhibition method was devised that detects antibodies against the M-f... more An enzyme immunoassay (EIA) inhibition method was devised that detects antibodies against the M-factor, a major protein antigen in histoplasmin. Purified M-factor still contains a large amount of a carbohydrate antigen impurity, but this can be inactivated by periodate oxidation. The resulting product improves the performance of the EIA to detect anti-M by (a) giving a more specific measurement, (b) increasing the percent inhibition in sera that contain antibodies to M-factor, and (c) increasing the precision in measuring negative reactions. An inhibition of 20% or greater is recommended for recording a result as positive.
In July 1996 the Washington State Department of Health (Seattle) was notified of a cluster of a f... more In July 1996 the Washington State Department of Health (Seattle) was notified of a cluster of a flulike, rash-associated illness in a 126-member church group, many of whom were adolescents. The group had recently returned from Tecate, Mexico, where members had assisted with construction projects at an orphanage. After 1 member was diagnosed with coccidioidomycosis, we initiated a study to identify further cases. We identified 21 serologically confirmed cases of coccidioidomycosis (minimum attack rate, 17%). Twenty cases (95%) occurred in adolescents, and 13 patients (62%) had rash. Sixteen symptomatic patients saw 19 health care providers; 1 health care provider correctly diagnosed coccidioidomycosis. Coccidioides immitis was isolated from soil samples from Tecate by use of the intraperitoneal mouse inoculation method. Trip organizers were unaware of the potential for C. immitis infection. Travelers visiting regions where C. immitis is endemic should be made aware of the risk of acquiring coccidioidomycosis, and health care providers should be familiar with coccidioidomycosis and its diagnosis.
Sera from 71 patients with culturally proven nocardiosis were tested for precipitins against a po... more Sera from 71 patients with culturally proven nocardiosis were tested for precipitins against a pool of Nocardia asteroides and N. brasiliensis culture filtrates and against antigens from the supernatant of homogenized N. asteroides cells. A human nocardiosis case serum was used as a reference. Sera from 56 of the 71 cases were reactive with either the culture filtrate antigen, the homogenate antigen, or both antigens, resulting in an overall sensitivity of 79%. Sera from 35 of the patients (49%) were positive with the homogenate antigens, and 28 (39%) showed bands of identity with the reference serum. Sera from 50 nocardiosis cases (70%) were positive with the pooled culture filtrate antigens, and 29 (41%) produced bands of identity with the reference serum. Of 89 sera from patients with various systemic mycotic diseases, tuberculosis, or actinomycosis, 24 (27%) were positive with the nocardial homogenate antigens and 4 (4.5%) showed precipitin bands of identity. Thirty-five of the ...
Isolation and identification of pathogenic Aspergillus and Fusarium spp. from clinical materials ... more Isolation and identification of pathogenic Aspergillus and Fusarium spp. from clinical materials provide the most accurate means for establishing a diagnosis of infections by these molds. Such efforts, however, are not always successful. Histologic diagnosis also has its limitations. In vivo the hyphae of Aspergillus and Fusarium spp. are very similar and their in situ manifestations are not pathognomonic. To improve the histologic diagnosis of infections by Aspergillus and Fusarium species, we developed polyclonal fluorescent-antibody reagents to Aspergillus fumigatus and Fusarium solani and evaluated their diagnostic utilities. Our studies revealed that A. fumigatus and F. solani share epitopes not only with one another but also with other Aspergillus and Fusarium spp. as well as with Paecilomyces lilacinus and Pseudallescheria boydii. Adsorption of the A. fumigatus conjugate with cells of Fusarium proliferatum and F. solani and F. solani antiserum with cells of Aspergillus flavus...
Disseminated penicilliosis marneffei is an emerging opportunistic mycosis seen in severely immuno... more Disseminated penicilliosis marneffei is an emerging opportunistic mycosis seen in severely immunocompromised human immunodeficiency virus (HIV)-infected patients and is caused by the dimorphic fungus Penicillium marneffei. Early diagnosis and treatment improve clinical outcome. Proper diagnosis is complicated by nonspecific signs and symptoms and by difficulties in histologic recognition and species identification of the pathogen. Since no established immunodiagnostic methods for penicilliosis marneffei are available, we attempted to develop separate immunodiffusion tests to detect P. marneffei antigens and antibodies in patient serum specimens and a latex agglutination test for antigenemia. Antigens consisted of 2-week-old fission arthroconidial filtrates produced in Pine's broth at 37 degrees C. Rabbit antisera were prepared against the 10 x -concentrated filtrate antigens. Studies were carried out with 17 serum specimens from HIV-seropositive adult Thai patients with penicill...
Kaufman, Leo (Communicable Disease Center, Atlanta, Ga.) and William Kaplan . Preparation of a fl... more Kaufman, Leo (Communicable Disease Center, Atlanta, Ga.) and William Kaplan . Preparation of a fluorescent antibody specific for the yeast phase of Histoplasma capsulatum . J. Bacteriol. 82: 729–735. 1961.—Rabbit anti- Histoplasma capsulatum globulin was conjugated with fluorescein isothiocyanate. This labeled antibody, in addition to staining six strains of H. capsulatum , exhibited strong cross-staining with ten strains of Blastomyces dermatitidis and numerous other species of fungi. Adsorption of the labeled antiglobulin either twice with cells of B. dermatitidis or twice with cells of Coccidioides immitis and once with cells of B. dermatitidis resulted in a good staining fluorescent antibody reagent, specific for yeast phase cells of H. capsulatum . Attempts to define the specific labeled antibody by the Ouchterlony procedure were unsuccessful. The specific conjugate did not give a complement fixation titer with yeast phase cells of B. dermatitidis or with coccidioidin. It did, ...
The diagnosis of penicilliosis marneffei can be difficult because the clinical manifestations mim... more The diagnosis of penicilliosis marneffei can be difficult because the clinical manifestations mimic those of tuberculosis, histoplasmosis, and other mycotic infections. Furthermore, the tissue form of Penicillium marneffei can be confused with those of Histoplasma capsulatum and Cryptococcus neoformans. To facilitate the rapid detection and identification of P. marneffei in clinical materials, we sought to develop a specific indirect fluorescent-antibody (IFA) reagent for this dimorphic pathogen. Preliminary IFA studies with yeast-like cells (fission arthroconidia) of P. marneffei indicated that these cellular elements stained with antiglobulins against culture filtrate antigens and whole yeast-like cellular antigens. Both types of antiglobulins reacted with the yeast-like cells of P. marneffei and with H. capsulatum, but not with their respective mycelial forms. The antiglobulins also failed to react with the yeast and hyphal forms of a variety of other heterologous fungi. Specific...
Conventional serodiagnosis of Pythium insidiosum infections involves the use of the immunodiffusi... more Conventional serodiagnosis of Pythium insidiosum infections involves the use of the immunodiffusion (ID) test. This test specifically diagnoses human and animal pythiosis. The test, however, has limited sensitivity and does not detect some culturally proven cases of the disease. Because of the increased recognition of pythiosis among humans and animals, we developed and evaluated an enzyme-linked immunosorbent assay (ELISA) using a soluble antigen from broken hyphae of P. insidiosum. Studies were carried out with sera from five humans and eight animals with culturally and/or histologically proven pythiosis. Some of these sera were negative in the ID test for pythiosis. Heterologous case sera from thirteen humans and two horses, plus 5 sera from healthy humans and 17 from healthy animals, were tested. Of the pythiosis case sera tested, the ID test detected only 8 of 13 (61.5%), whereas the ELISA detected all of them (100%). The ID and ELISA tests were entirely specific and gave negat...
A western blot (WB) test was evaluated for detection of antibodies against native glycosylated an... more A western blot (WB) test was evaluated for detection of antibodies against native glycosylated and chemically deglycosylated M and H antigens of Histoplasma capsulatum in serum obtained from patients during the acute phase of pulmonary histoplasmosis that occurred during an outbreak. Of 275 serum samples tested by immunodiffusion and complement fixation (CF) samples from 40 patients affected during this outbreak and from 37 negative controls were tested by WB test. A group of patients whose sera were negative for CF antibodies and precipitins early in the acute stage of histoplasmosis but who all seroconverted during convalescence 6 weeks later were tested with the WB test. Antibodies against untreated H and M antigens were detected at a 1:100 dilution by WB test in 45% of the 20 acute-phase serum samples and in all 20 of the convalescent-phase specimens. The WB test’s sensitivity for acute-phase specimens increased to 90% (18 of 20 specimens) when H and M antigens were treated by p...
Numerous reports have indicated that a single histoplasmin skin test may stimulate humoral antibo... more Numerous reports have indicated that a single histoplasmin skin test may stimulate humoral antibodies to Histoplasma capsulatum antigens in histoplasmin-hypersensitive individuals. Although these investigations concur that antibody elevations are evoked, they vary in the reported degree of incidence and response induced, and they cast doubt on the interpretation of serological tests in the diagnosis of histoplasmosis. Histoplasmin-hypersensitive subjects (114) were bled prior to administration of the skin test, 2 days later, at the time this test was read, and 15 and 30 days after testing. No significant antibody titers were observed at 2 days. At 15- and 30-day intervals, only 17 (15%) of the subjects demonstrated circulating antibodies. All 17 showed agar gel bands; 5 demonstrated no complement-fixation (CF) titers, 10 produced CF antibodies ranging from 1:8 to 1:16, and 2 demonstrated titers of 1:32. The data suggest that skin testing does not interfere significantly with antibod...
Kaufman, Leo (Communicable Disease Center, Atlanta, Ga.), and Sharon Blumer . Occurrence of serot... more Kaufman, Leo (Communicable Disease Center, Atlanta, Ga.), and Sharon Blumer . Occurrence of serotypes among Histoplasma capsulatum strains. J. Bacteriol. 91: 1434–1439. 1966.—Extensive studies with a fluorescent antibody specific for the yeast form of Histoplasma capsulatum indicated that, although most strains of H. capsulatum stained intensely, others stained weakly and some did not stain. These observations suggested that antigenic variants of the fungus existed. To test this hypothesis, reciprocal cross-staining and adsorption procedures were performed with fluorescein-labeled antiglobulins to four strains of H. capsulatum . Fifty-six strains of H. capsulatum and 11 strains of H. duboisii were studied. The data indicate that at least five serotypes of H. capsulatum occur. One is closely related antigenically to H. duboisii and Blastomyces dermatitidis .
Complement fixation titers of 1:2 and 1:4 with coccidioidin are not always of diagnostic signific... more Complement fixation titers of 1:2 and 1:4 with coccidioidin are not always of diagnostic significance. The concurrent use of the complement fixation and immunodiffusion tests is an effective means for specific serologic diagnosis of coccidioidomycosis in patients with low levels of complement-fixing antibodies. In routine testing, it is recommended that only sera that are negative for complement-fixing antibodies at 1:8 but positive in the immunodiffusion test with coccidioidin be selected for titration at the 1:2 and 1:4 levels.
A newly developed latex agglutination (LA) test and a modified immunodiffusion (ID) test were eva... more A newly developed latex agglutination (LA) test and a modified immunodiffusion (ID) test were evaluated. The antigen used was a homogenate of Candida albicans. A total of 167 antisera were employed in the evaluation. They included 36 sera from clinically well persons; 78 from patients with various clinical forms of candidiasis; 52 from patients with proven cases of aspergillosis, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, nocardiosis, paracoccidioidomycosis, sporotrichosis, and tuberculosis; and one serum from a patient with torulopsosis. Use of the LA test in conjunction with the ID test permitted the detection of more than 90% of 43 proven candidiasis cases. Of all the heterologous cases and normal human sera tested, LA reactions were noted with 3 of 10 cryptococcosis case specimens, 1 of 9 tuberculosis case specimens, and with the torulopsemia case serum. In contrast, the only heterologous serum reactive in the ID test was that from the patient with torulopsemia. Torulopsis glabrata and C. albicans antisera gave identical reactions in LA and ID tests with T. glabrata or C. albicans antigens. ID tests with selected antigens, however, permitted differentiation of rabbit and human T. glabrata antibody from that of C. albicans antibody. Six different precipitins were recognized with the C. albicans antigens. The occurrence of multiple precipitin lines and high LA titers was suggestive of severe candidiasis. The LA test, in contrast to the ID test, appeared to have prognostic value. Together, the LA and ID tests provided a simple, rapid, and accurate means of detecting and monitoring infections by species of Candida.
Maximal serological diagnosis of cryptococcosis may be accomplished through the concurrent use of... more Maximal serological diagnosis of cryptococcosis may be accomplished through the concurrent use of three tests: the latex agglutination (LA) test for cryptococcal antigen, and the indirect fluorescent antibody (IFA) and tube agglutination (TA) tests for Cryptococcus neoformans antibodies. These tests were applied to 141 serum and cerebral spinal fluid specimens from 66 culturally proven cases of cryptococcosis and to 42 sera from normal subjects and from patients with other systemic mycotic diseases. The LA test was sensitive and completely specific; of the sera from proven cases, 55% were positive. With the TA test, 37% of the specimens were positive and the test was highly specific. With the IFA test, 38% of the specimens were positive and the test appears to be the least specific of the three. Cross-reactions were most evident with blastomycosis and histoplasmosis case sera. When the three tests were used concurrently, 87% of the cryptococcosis case specimens were positive and permitted a presumptive diagnosis of C. neoformans infections in 61 (92%) of the 66 patients whose specimens were examined.
Previous studies have shown that a single skin test to histoplasmin may induce complement-fixing ... more Previous studies have shown that a single skin test to histoplasmin may induce complement-fixing antibodies or M precipitins (or both) to histoplasmin in histoplasmin-sensitive, but serologically negative, individuals. Ideally a skin-test antigen should be one which detects hypersensitivity without stimulating humoral antibodies. Histoplasmin skin-test antigens presently used contain both H and M antigens. The present study was undertaken to evaluate an histoplasmin skin-test antigen deficient in the M component but containing the H antigen. Thirty histoplasmin-hypersensitive subjects were bled prior to administration of the experimental skin-test antigen and at various time intervals thereafter. Only six of the thirty hypersensitive subjects showed serological responses. The sera of the six, however, only showed weak precipitin reactions, five showed M bands, and only one showed an M and an H band. None showed complement-fixation titers with either the yeast or mycelial antigens of Histoplasma capsulatum. Our data suggest that the use of a skin-test antigen purified to contain only H component would detect histoplasmin hypersensitivity without inducing antibodies and would eliminate false-positive serological reactions caused by the M component.
The American Journal of Tropical Medicine and Hygiene, 1999
In June 1994, 18 people developed serologically confirmed histoplasmosis following cave explorati... more In June 1994, 18 people developed serologically confirmed histoplasmosis following cave exploration associated with the annual National Speleological Society Convention in Bracketville, Texas. Six others had an undiagnosed illness suspected to be histoplasmosis. Two persons were hospitalized. We conducted a survey of convention attendees and a nested case-control study of those entering caves. We also conducted a histoplasmin skin test survey of a subgroup of the society, the Texas Cavers Association, who were attending a reunion in October 1994. Among the national convention attendees, exposure to two caves was identified as responsible for 22 (92%) of the 24 cases; 12 (75%) of 16 people exploring one cave (Cave A) and 10 (77%) of 13 exploring a separate cave (Cave B) developed acute histoplasmosis. Additional risk-factors included fewer years of caving experience, longer time spent in the caves, and entering a confined crawl space in Cave A. Of 113 participants in the separate skin test survey, 68 (60%) were found to be skin test positive, indicating previous exposure to Histoplasma capsulatum. A positive skin test was significantly associated with male sex and more years of caving experience. Those less experienced in caving associations should be taught about histoplasmosis, and health care providers should pursue histories of cave exposure for patients with bronchitis or pneumonia that does not respond to initial antibiotic therapy.
Identification of the newly named pathogenic oomycete Pythium insidiosum and its differentiation ... more Identification of the newly named pathogenic oomycete Pythium insidiosum and its differentiation from other Pythium species by morphologic criteria alone can be difficult and time-consuming. Antigenic analysis by fluorescent-antibody and inmunodiffusion precipitin techniques demonstrated that the P. insidiosum isolates that cause pythiosis in dogs, horses, and humans are identical and that they were distinguishable from other Pythium species by these means. The immunologic data agreed with the morphologic data. This indicated that the animal and human isolates belonged to a single species, P. insidiosum. Fluorescent-antibody and immunodiffusion reagents were developed for the specific identification of P. insidiosum.
An enzyme immunoassay (EIA) inhibition method was devised that detects antibodies against the M-f... more An enzyme immunoassay (EIA) inhibition method was devised that detects antibodies against the M-factor, a major protein antigen in histoplasmin. Purified M-factor still contains a large amount of a carbohydrate antigen impurity, but this can be inactivated by periodate oxidation. The resulting product improves the performance of the EIA to detect anti-M by (a) giving a more specific measurement, (b) increasing the percent inhibition in sera that contain antibodies to M-factor, and (c) increasing the precision in measuring negative reactions. An inhibition of 20% or greater is recommended for recording a result as positive.
In July 1996 the Washington State Department of Health (Seattle) was notified of a cluster of a f... more In July 1996 the Washington State Department of Health (Seattle) was notified of a cluster of a flulike, rash-associated illness in a 126-member church group, many of whom were adolescents. The group had recently returned from Tecate, Mexico, where members had assisted with construction projects at an orphanage. After 1 member was diagnosed with coccidioidomycosis, we initiated a study to identify further cases. We identified 21 serologically confirmed cases of coccidioidomycosis (minimum attack rate, 17%). Twenty cases (95%) occurred in adolescents, and 13 patients (62%) had rash. Sixteen symptomatic patients saw 19 health care providers; 1 health care provider correctly diagnosed coccidioidomycosis. Coccidioides immitis was isolated from soil samples from Tecate by use of the intraperitoneal mouse inoculation method. Trip organizers were unaware of the potential for C. immitis infection. Travelers visiting regions where C. immitis is endemic should be made aware of the risk of acquiring coccidioidomycosis, and health care providers should be familiar with coccidioidomycosis and its diagnosis.
Sera from 71 patients with culturally proven nocardiosis were tested for precipitins against a po... more Sera from 71 patients with culturally proven nocardiosis were tested for precipitins against a pool of Nocardia asteroides and N. brasiliensis culture filtrates and against antigens from the supernatant of homogenized N. asteroides cells. A human nocardiosis case serum was used as a reference. Sera from 56 of the 71 cases were reactive with either the culture filtrate antigen, the homogenate antigen, or both antigens, resulting in an overall sensitivity of 79%. Sera from 35 of the patients (49%) were positive with the homogenate antigens, and 28 (39%) showed bands of identity with the reference serum. Sera from 50 nocardiosis cases (70%) were positive with the pooled culture filtrate antigens, and 29 (41%) produced bands of identity with the reference serum. Of 89 sera from patients with various systemic mycotic diseases, tuberculosis, or actinomycosis, 24 (27%) were positive with the nocardial homogenate antigens and 4 (4.5%) showed precipitin bands of identity. Thirty-five of the ...
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Papers by Leo Kaufman